Adults in New Hampshire’s Medicaid program will have access to cleanings, fillings, X-rays and other basic dental care for the first time, under a new benefit that starts Saturday.
The new coverage — long sought by oral health advocates — is the result of legislation signed last year. Until now, New Hampshire has been one of a small number of states that has limited Medicaid dental coverage to emergencies.
“These are folks that have had either very limited or no access to dental care, perhaps for years — and for some of them, perhaps for a lifetime,” said Gail T. Brown, director of the New Hampshire Oral Health Coalition, which advocates for greater access to dental care.
She estimated as many as 88,000 people in the state could qualify. The new benefit is capped at $1,500 per year, not counting preventive services. It also comes with a service that can arrange transportation for people who need help getting to appointments.
Dentists and other advocates said the expanded access to dental care could prove critical for individuals’ overall physical health, work prospects and social and emotional well-being.
“The mouth is part of the body,” said Dr. Brenda Berkal, the president of the New Hampshire Dental Society. “It has been separated by insurance and by legislation, but it's not. Health care includes oral health care.”
For many of those new patients, it could be a while before they get in for an appointment. Dentists are already extremely busy with their current patients — and so far, only a limited number have signed up to accept Medicaid payments.
Tom Raffio is president and CEO of Northeast Delta Dental, which is administering the benefit under a $33.5 million state contract. He said Medicaid pays much less than private insurers, which has made it hard to recruit enough providers.
“The biggest challenge has been getting dentists and oral surgeons to sign up, because, in effect, they're taking probably 50 cents on the dollar from their regular fees,” he said.
Raffio thinks the network needs 200 to 300 dentists accepting Medicaid to meet the demand. As of Friday, it had signed up 75, though that includes providers in every county.
Northeast Delta Dental increased some fees after hearing from dentists — though they still won’t match private insurance — and has offered $1,000 cash incentives to any providers who join the network before Saturday.
The company has also been appealing to dentists’ sense of public service and encouraging as many as possible to take at least a few patients, to help share the load, he said.
Raffio said Northeast Delta Dental intends to keep up the “full court press” to attract more providers throughout the rest of this year, even as dental benefits go live.
“It's going to probably take six months to a year to get the network to where, you know, I would be happy,” he said.
Berkal said the Dental Society has been working with Northeast Delta Dental to encourage dentists to accept Medicaid. She signed her own practice up in recent weeks.
“I do like the thought of basically giving back,” she said. “Because even though there is a payment, it is much less than my typical fee.”
In Tilton, Dr. Kristine Blackwelder is eager to start serving adults who are gaining dental coverage for the first time. Some include the parents of children she’s seen for a while. (State Medicaid programs are required to cover dental services up to age 21.)
But between staff shortages and the current workload, her practice is already maxed out.
“We have not been able to accept a new patient since even before COVID,” she said. “We're just at capacity.”
Dr. Jeffrey Vachon said his Manchester practice has had a longstanding commitment to serving patients with Medicaid since his father founded it in the 1970s. But because of Medicaid’s low payment rates, they have to balance that with privately insured patients to be financially sustainable and maintain quality.
“We have actually had to put a little bit of a pause on accepting new Medicaid patients,” Vachon said.
When it comes to the new adult benefit, he said they plan to take on a few patients at first to try it out.
“It's going to be a new program — the reimbursement schedule, the reimbursement timeline and how quickly we get reimbursed,” he said. “So all that is new to everyone. So we really want to make sure it makes sense from a business standpoint.”
In the North Country, Coos County Family Health is expecting a significant increase in demand once the new benefit rolls out, said CEO Ken Gordon.
The community health center is working to expand capacity, but that will take time. It plans to open a dental clinic in Colebrook this fall, and expand its Berlin clinic next year with help from federal funds.
“We are really busy with current patients,” he said. “We are booking out some four to six months. And so I think the entire system will struggle to accommodate the additional influx.”
He and others urged people to be patient as they try to make new appointments.
Raffio, of Northeast Delta Dental, said people suffering from acute pain will be fast-tracked so they can see a provider as soon as possible.
But routine appointments could take much longer to schedule. Even for people with private insurance right now, he said, “it might take you six months to get a cleaning.”
Northeast Delta Dental is holding two mobile dental clinics exclusively for adult Medicaid patients Saturday. Dentists and dental hygienists will be available for exams, fillings, restorations and other services..
The clinics will be at Northeast Delta Dental’s office on Delta Drive in Concord and at Upper Connecticut Valley Hospital in Colebrook. People are encouraged to make appointments by calling 877-248-6684.
